John Crown (Independent) | Oireachtas source

I do not normally do this, but I will read a brief article which was written a few years ago by Dr. Ken Murray, an American general practitioner. I found it extraordinarily informative and moving. It is one everybody looking at changing policy on end-of-life care should read. He wrote:

It's not a frequent topic of discussion, but doctors die, too. And they don't die like the rest of us. What's unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don't want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They've talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen - that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR [cardio pulmonary resuscitation] (that's what happens if CPR is done right).
Almost all medical professionals have seen what we call "futile care" being performed on people. That's when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you'll kill me." They mean it. Some medical personnel wear medallions stamped "NO CODE" to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they'll vent. "How can anyone do that to their family members?" they'll ask. I suspect it's one reason physicians have higher rates of ... depression than professionals in most other fields.

We have a colossal job to enable rational humane end-of-life care to become the culture, not only among the caring professions, medicine and nursing, but also in society at large. This is an appropriate co-operative collegial gathering and I do not mean to pick holes in the arguments of others because everybody is singing from the same hymn sheet, but one should be a little careful in talking about over-medicalising because throughout history and contemporary current affairs there are examples of medically unassisted dying processes which can be miserable, uncomfortable and painful and characterised by great anguish. In general, what we want is not to overly and inappropriately medicalise death, but the presence of skilled health professionals, doctors and nurses, is something for which I myself would wish when I am at the end of my life.
There are unbelievable imperatives to get this right such as the inevitability of death. This is a health service which we will have to provide for every person. It is uniquely a health service in which we are guaranteed not to receive consumer feedback. We must ensure we do it right on behalf of the people who cannot tell us if we are doing it wrong. For all of these reasons, we need to undertake a job of education in medical schools about futile care, which to be honest is happening. We also need to undertake a significant job of education with society at large that it is not humane to insist on doctors doing that final test or extra investigation, or putting the patient through that treatment; that if somebody puts his or her hand on a relative's shoulder and says their loved one should not go to the intensive care unit, it is not because he or she is trying to save money for the health service but because it is bad medicine, not something one would want to have done under the circumstances.
In attempting to get this right and prevent over-medicalisation, there is something else we really must do. We have to prevent the over-legalisation of medical care because the tendency to practise defensive medicine does not end when a person's prognosis is for short survival. At that time, more than ever, doctors can be nervous that in the heightened emotive environment of end-of-life care, if they do something which the family does not either necessarily agree with or fully support, they may face consequences. This can sometimes be a powerful motivation for doctors to do what they would not want to be done to themselves.
I commend the motion, the process involved and the hearings of the Joint Committee on Health and Children. This is a critically important part of the provision of health care.

I will make one practical observation. Not only is it right from a humane and social point of view to do this medically, it also makes sense in terms of health service resources. I am not saying we should economise in caring for the dying but doing it wrong is not only wrong but also more expensive. I am not saying people do not deserve to have these resources provided when their prognosis is that their life expectancy is short; they do not lose their rights when their life expectancy is short, but we are putting them through things that are bad for them.